Examples: Hyrimoz, Amgevita, Humira

Adalimumab decreases inflammation by suppressing a part of the body called the immune system. It is an advanced type of medicine which has a far more specific effect on the immune system than conventional therapies. The target for adalimumab is called tumor necrosis factor alpha (TNFα). Adalimumab inhibits TNFα using a new medical technology called a monoclonal antibody, which has been designed to mimic natural components of the body's immune system.

How do I take adalimumab?

Adalimumab is administered by injection under the skin (subcutaneous injection). It is available as a pre-filled pen device which can be self-administered or given to you by a partner or family member. You will be shown how to use this before starting treatment. Adalimumab can be injected on the front of your thighs or your belly (at least 5cm away from your belly button). You should rotate injection sites to help prevent irritation. The first dose of adalimumab is 80mg (two 40mg injections in one day), followed by 40mg (one injection) every other week starting one week after the first dose. This medicine should be stored in the fridge.


Can I carry on taking my other medications?

Due to the potential risk of the drug interacting with other medicines, you should inform us about any medication you are currently taking, or any new medicines you have been prescribed. This includes any medications bought at a pharmacy without a prescription. To ensure you remember everything, it may be helpful to bring a list of current medications with you to your appointments. You should also inform us if you have any allergies.

Adalimumab can take several weeks to take effect. You will be reviewed regularly to monitor your response to treatment. You should continue to use any other medication you have been prescribed for your eye(s) until you have been reviewed and advised to change.


What else do I need to be aware of before taking adalimumab?

Previous medical issues

Before starting adalimumab you will visit a specialist pharmacist led screening clinic. This clinic will check it is safe for you to start adalimumab. You will be asked if you have ever had tuberculosis (TB) and if you have any risk factors for developing TB. You may be referred to a chest physician if we think you are at risk. You will be asked if you have any other active infections or a history of persistent infections. You will also be asked if you have a diagnosis or symptoms suggestive of multiple sclerosis (MS). If this is the case or you have a particular sort of inflammation associated with MS we will arrange a brain MRI scan. We will ask if you have had a previous diagnosis of cancer or any history of heart disease.

During your visit to the adalimumab screening clinic you will have a range of blood tests, a chest X-ray (unless you have had a recent chest X-ray), a urine test and a pregnancy test. We will measure your height, weight and blood pressure. You will also have a physical examination by a doctor. This examination will require you to undress so the doctor can examine your skin, listen to your heart and lungs and feel your abdomen. Some patients will be offered a breast examination. If this is done by a male doctor, a female chaperone will be present throughout the examination. You will be provided with information on adalimumab and given opportunity to ask questions. Depending on the outcome of your visit, referrals to other specialists and further tests may be needed.


Pregnancy, contraception and breast-feeding

Female patients will have a pregnancy test before beginning treatment. If you are planning to have children whilst using adalimumab, please let us know as this would require further discussion, as there are some risks including a higher risk of infection for your baby. If you become pregnant whilst using adalimumab you should contact us immediately. Adalimumab can be used during breast feeding.


Infections and vaccinations

Because adalimumab affects the immune system it can make you more likely to pick up infections and it can also make them harder to spot. Therefore you should avoid close contact with people who have viral infections, in particular chicken pox, shingles and measles. If you develop these, you should seek medical advice immediately. Tell your doctor straight away if you develop any signs of infection or any new symptoms that concern you whilst using adalimumab and for up to six months after stopping. Signs of infection may include fever, chills, cough, vomiting, diarrhoea, sore throat, night sweats, fatigue, weight loss, stinging when you urinate or blood in your urine.

If you have any surgery or dental procedures whilst using adalimumab you should let your surgeon or dentist know that you are using adalimumab. You may need to stop adalimumab for some time before and after the surgery.

You should not have live vaccines whilst using adalimumab. Ask your doctor, nurse or pharmacist before having any vaccinations. We do however recommend you have a Pneumovax (pneumococcal) vaccine six weeks before starting adalimumab. This will help protect you from developing some chest infections. You should also have an annual flu vaccination. We will write to your GP and request they provide this for you.


Food preparation

There are some reports of bacteria (germs) found in food that may cause a problem to those who are less able to fight infections. Your body’s resistance to infection can be reduced while you are taking adalimumab. Meat should be cooked thoroughly, and raw seafood such as oysters and sushi should be avoided. Ensure salads are washed well with hot water and avoid ready-prepared supermarket salads. Do not consume unpasteurized dairy products e.g. brie, camembert.



Uncommonly, adalimumab can cause side effects which may influence your ability to drive such as vertigo (room spinning sensation) and visual disturbances. If affected, do not drive or operate machinery.



You are advised not to drink more than 14 units of alcohol per week, spread evenly over three or more days, on a regular basis. 14 units is equivalent to six pints of average-strength beer or 10 small glasses of low-strength wine.


Sun exposure

Take care to avoid too much sun (including sunbeds) whilst taking this medicine and use a sunscreen with a high protection factor e.g. SPF 50.


Which tests will I need and how often will I need them?

It is important that you are regularly checked whilst using adalimumab. Therefore, before starting treatment an initial blood test will be carried out. A blood test is then usually needed at least every 12 weeks. This may vary depending on your condition and may need to be more frequent. It is your responsibility to ensure that you have your blood tests on time. It is important that you do not miss these. For your safety your adalimumab prescription will not be renewed unless recent blood results are available.


What are the side effects?

As with most medicines, adalimumab may cause side-effects, although this is not the case for everyone. Most side effects are mild to moderate however some may be serious and require treatment.

Possible side-effects include:

In addition to infection, the most common side effects are reactions at the injection site (e.g. pain, swelling, redness, itching). Regularly changing the site of injection can help prevent irritation.


Rare side effects include:

Rarely, people may have an allergic reaction. Symptoms of this might include severe rash, hives, swollen face, hands, feet and trouble breathing and / or swallowing. Seek emergency medical help if you think this is happening. If the reaction is severe we will take you off adalimumab. If you experience swelling of the feet or shortness of breath (with physical activity or when lying down), please contact us.

Anti-TNF drugs have been associated with some types of skin cancer – these can be readily treated when diagnosed early. Research so far hasn’t confirmed an increased risk of other cancers.


Need more information?

Please refer to the leaflet included with the medicine for further information, or contact the pharmacy department on: 020 7521 4691